Impact of Paternal Genome with a High DNA Fragmentation Index (>60%) on Early Embryonic Development

: Objectives: The objective of this study is to propose thresholds of the sperm DNA fragmentation rate (IFA≤30% IFA31%-60% IFA>60%), in order to assess the clinical effects of the paternal genome on intra cytoplasmic sperm injection parameters, in particular the effect of the latter on early embryonic development. Materials and Methods: The procedure is a retrospective study, which involved 101 patients enrolled in an ICSI program with their partners. The index of spermatic DNA fragmentation rate was measured using the Sperm Chromatin Dispersion assay. Results: There is a negative correlation between high levels of the spermatic DNA fragmentation index and spermiological characteristics: Concentration P=0.002 and mobility P=0.0001. For ICSI results, there are different observations on the existence of a correlation between the spermatic DNA fragmentation index and fertility rate. On the other hand, the rate of sperm DNA fragmentation does not seem to influence early embryonic development, and even couples whose partners have a high fragmentation index manage to obtain the best quality embryos (P=0.002). We observe a decrease in the rate of implantation with an increase in the rate of alteration of the sperm genome, but this remains insignificant P > 0.05. Conclusion: ICSI remains the only alternative for men with a high rate of sperm DNA fragmentation. Moreover, the operator seems to influence the results more than is suggested. This does not exclude the paternal effect which may influence the quality of the concepltus later on. Keywords: DNA Fragmentation Index, ICSI, Fertilization Rate, Embryos Quality.

Perinatal Outcomes After Undergoing External Cephalic Version

: The external cephalic version (ECV) represents the standard for pregnancies at term with a non-cephalic presentation as it avoids planned caesareans. The aim of this study was to assess the caesarean rate and prognostic factors at birth after undergoing ECV, which was compared with scheduled caesareans for a non-cephalic presentation (SCG) and spontaneous cephalic presentations at birth (GG). No difference was observed between the caesarean rate of the ECV (n=65) and the GG (n=3711) groups (9.84% and 14.47%, respectively, p-value=0.30), and neither was found between the ECV group and both the GG and SCG (n=76) groups in the Apgar scores and postpartum pH, but for the five-minute Apgar score (9.98 and 9.84 in the ECV and SCG groups, respectively, p-value=0.04). This study provides further evidence for clinical practice regarding good perinatal outcomes after undergoing ECV. Further research is required to consistently prove the increase in the intrapartum caesarean rate after ECV that has been previously described in the literature, which has not been found in the present study. Keywords: External Cephalic Version, Breech Presentation, Caesarean Rate, Perinatal Outcomes, Apgar Score, Postpartum Ph.

Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population-Based Ecological Study

Purpose: This study aims to explore the relationship between population-level caesarean section rates (CSRs) with maternal and neonatal mortality rates (MMR, NMR) in the Eastern Mediterranean Region (EMR). Design: A populationbased ecological study was performed with data obtained from the World Health Organization, Global Health Observatory database, 2015, United Nations Inter-agency Group for Child Mortality Estimation (UN-IGME) and the United Nations Maternal Mortality Estimation Inter-Agency Group (UN-MMEIG) 2015). Mean ± standard deviation (SD), range, median and Interquartile range (IQR) were used to describe the quantitative data. We performed multivariate logistic regression analysis to explore the effect (a) of (a) Antenatal clinic visits (ANC %), (b), Skilled Birth Attendance (SBA) rate (% of deliveries attended by SBA), (c) Total Health Expenditure (THE) per capita and (d) Female Literacy Rate (FLR%) on the studied relationship. Spline linear regression was used to find the most predictive variable for MMR, and the NMR. Statistical significance was accepted at P<0.05. Results: The mean CSR was 21.20±13.38, (1.8-52). The CSR of <10% was linked with the highest NMR and MMR, 33.0 (24.0-39.0) and 390.5(329.5-648.0) respectively. The most predictable variables for NMR and MMR were SBA % [B=-0.875; p< .001; R2=0.766 and adjusted R2=0.754] and FLR (F=15-24) [B=0.877; P<0.001; R2=0.77 and adjusted R2=0.758] respectively. Conclusions: We found a statistically significant inverse relationship between CSRs and maternal and neonatal mortality in MSs with <10% of CSR. The improved mortality rates in MSs with >15% of CSR were significantly linked with better socioeconomic and healthcare variables than higher CSRs. Keywords: Caesarean Section, Maternal and Neonatal Mortality, Eastern Mediterranean Region.

First Ovarian Tissue Cryopreservation and Autotransplantation in Patients with Malignancies in Hungary – Report of the First Three Cases

Fertility Preservation, Cryopreservation, Ovarian Tissue Autotransplantation and Malignancies. Abstract: Autotransplantation of cryopreserved ovarian tissue is one of the most advanced methods for fertility preservation of patients suffering from malignant diseases. Even though the method itself is still experimental, nearly a hundred live births have been documented worldwide, and its efficacy is comparable with the efficacy of any other assisted reproductive technology. Our prospective, nonrandomized study was the first in Hungary that aimed to examine the safety and efficacy of fertility preservation based on ovarian tissue cryopreservation and autotransplantation. Patients were included only with stage I-III malignancy confirmed by histological diagnosis with a high risk for post-treatment infertility. 13 patients met the inclusion criteria and were enrolled in the study. After successful treatment and recovery, cryopreserved ovarian tissue was thawed and autotransplanted in three cases. The ultrathin slices of ovarian cortex were transplanted on the remaining ovaries with laparoscopic or minilaparotomic intervention. Patients were discharged home after an uneventful postoperative period and are followed up currently. In summary, cryopreservation and autotransplantation of ovarian tissue is a safe technology for fertility preservation, which should be considered to offer and perform prior to gonadotoxic treatment, after individual evaluation of patients

Impact and Repercussion of the SARS-CoV-2 Pandemic in the Assisted Reproduction Units in Spain

Summary: During the months of March, April and May of 2020 the Spanish Assisted Reproduction Units had to stop their assistance activity due to the health situation caused by the COVID-19 pandemic. Its reactivation has required a substantial modification in the way of working in them, changing the assistance routines and designing protocols that guarantee, as much as possible, the security of patients and staff of the centers devoted to reproductive medicine.It is analyzed the medical and biological arguments that have been assessed in order to advise the reopening of the Assisted Reproduction Units within the current context of the pandemic in Spain and the European Union.